Abstract
Background: Virtual reality (VR) as a distraction tool decreases anxiety and fear in children undergoing procedures, but its use has not been studied during transthoracic echocardiograms (TTEs). We hypothesized that VR in children undergoing pre-intervention TTEs decreases anxiety and fear and increases TTE study comprehensiveness and diagnostic accuracy when compared with standard distractors (television, mobile devices).
Methods: Patients (6-18 years old) scheduled for pre-intervention TTEs at Lucile Packard Children’s Hospital in 2021 and 2022 were prospectively enrolled and randomized to VR and non-VR groups. Patients completed pre- and post-TTE surveys using the Children’s Anxiety Meter-State (CAM-S) and Children’s Fear Scale (CFS). Patients, parents, and sonographers completed post-TTE experience surveys. TTEs were reviewed by pediatric cardiologists for study comprehensiveness and compared with electronic medical records for diagnostic accuracy.
Results: Among 67 enrolled patients, 6 declined VR, 31 randomized to the VR group, and 30 to the non-VR group. Anxiety (average CAM-S difference 0.78+1.80, p=0.0012) and fear (average CFS difference 0.36+0.74, p=0.0005) decreased in both groups. There was no difference between groups in the change in anxiety and fear pre- and post-TTE (p=0.96-1.00). TTE study comprehensiveness and diagnostic accuracy were high in both groups. Procedure time (time in the echocardiography room) was less for the VR group (48.4+18.1 minutes) than the non-VR group (58.8±24.4 minutes), but without a statistically significant difference (p=0.075).
Conclusions: VR is similar to standard distractors and may decrease procedure time. Patients, parents, and sonographers rated the VR experience highly and encouraged its use with future procedures.